Tru-cut Biopsy Research Articles

A Biopsy as a Rescue in a Case of Pancreatoblastoma with Vague Radiology Features

Paediatric pancreatic tumours are rare and mostly malignant. Because they present with vague clinical features, it is important to recognise them and make correct pathological diagnoses using radiological suggestions and histopathology. A one-year-old male child presented to the surgical outpatient department with complaints of abdominal pain for 4 months. The ultrasonography showed a lesion in the left suprarenal region. An ultrasound-guided trucut biopsy showed tumour cells with predominant glandular (acinar) and focal solid (squamoid) patterns with areas of necrosis and haemorrhage. A diagnosis of epithelial cell tumour was given, and IHC was advised. The PET CT scan showed an avidly heterogeneously enhanced large, well-defined soft tissue density lesion involving the left upper abdomen, measuring 5.6x5.6x4.9 cm. The lesion showed an internal zone of necrosis, haemorrhage, and calcification. However, no radiological possibility of a malignant mass lesion of the pancreas was suggested. On immunohistochemistry, the tumour cells were positive for AE1, CK7, beta-catenin, and AFP, along with Ki67, in 70% of tumour nuclei. Based on the morphology, immunohistochemistry, and clinicopathological findings, a diagnosis of pancreatoblastoma was given, and serum AFP levels were suggested. The mass was completely excised, and typical morphological features of the tumor were identified. The definite diagnosis may be challenging, especially when dealing with limited tumour tissue in biopsies. Integration of clinical, radiological, and histopathological findings is essential in pancreatoblastoma diagnosis. In cases of unusual presentation with vague radiologic findings, thorough knowledge of the histopathological features along with a precise IHC panel may help arrive at the diagnosis. Keywords: Pancreatoblastoma, Clinicoradiology, Histopathology, IHC, Survival

Unusual Presentation of Cryptogenic Organising Pneumonia as a Focal Lung Mass: A Case Report andLiterature Review.

Organising pneumonia (OP) is a distinct pathological pattern characterised by the presence of granulation tissue buds composed of fibroblasts and myofibroblasts embedded in a loose connective tissue matrix within the distal pulmonary airspaces. When OP occurs without an identifiable cause or etiologic context, it is termed cryptogenic organising pneumonia (COP). The diagnosis of OP can be challenging due to its diverse clinical presentations, including the idiopathic form and various secondary forms associated with underlying diseases. We report a case of a middle-aged male presenting with intermittent cough and haemoptysis. Initial sputum analysis was unremarkable, and the patient showed no improvement with antibiotic therapy. Chest radiography showed left lower zone consolidation. Computed tomography (CT) thorax revealed a mass in the left lower lobe, while positron emission tomography-computed tomography (PET/CT) demonstrated a hypermetabolic lesion at the same site. Bronchoscopic bronchoalveolar lavage was negative for tuberculosis, respiratory pathogens, and malignancy. Autoimmune screening yielded negative results. A transthoracic tru-cut lung biopsy confirmed the diagnosis of OP. The patient was treated with prednisolone, leading to significant clinical improvement and complete resolution of the lesion on follow-up CT imaging.

The Role Of Ultrasound Guided Tru-Cut Biopsy In Ovarian Cancer: A Systematic Review Of Its Adequacy, Accuracy And Safety.

The Role Of Ultrasound Guided Tru-Cut Biopsy In Ovarian Cancer: A Systematic Review Of Its Adequacy, Accuracy And Safety.

Comparison of percutaneous liver aspiration biopsy and tru-cut biopsy results

Aims: The aim of this study was to compare the diagnostic rates, complications and histopathologic diagnoses of aspiration biopsy and tru-cut biopsy procedures in liver parenchyma and to reveal the differences between the technical methods. Methods: Patients who underwent liver parenchymal biopsy in our hospital were identified. While tru-cut biopsy needle was used in the radiology department, aspiration biopsy needle was used in the gastroenterology department. Patients who underwent parenchymal biopsy were included in the study, while lesion biopsies were excluded. Indications for biopsy, presence of hepatitis, type of biopsy needle, number of times, size of biopsy material, pathologic diagnosis and complications after biopsy were evaluated. Results: Of the 113 patients who underwent liver biopsy, 74 were male (mean age 40.38.±17.37 years) and 39 were female (mean age 45.49±15.85 years). Among the patients who underwent liver biopsy, tru-cut biopsy needle was used in 46 patients, while aspiration biopsy needle was used in 67 patients. The biopsy size and number of pieces were statistically significantly higher in aspiration biopsy compared to tru-cut biopsy. There was no difference between the two biopsies in terms of diagnosis rate, complication development, fibrosis staging and score. Conclusion: Percutaneous aspiration and tru-cut biopsies are reliable diagnostic methods with high diagnostic rates and low complication rates. The fact that biopsy is performed by experienced hands, under US guidance, and the number of biopsies is limited reduces the development of complications.

COMPARISON OF ULTRASOUND-GUIDED TRUCUT NEEDLE BIOPSY AND LAPAROSCOPY IN THE DIAGNOSIS OF HIGH-GRADE SEROUS OVARIAN CANCER

OBJECTIVE: We aimed to compare tru-cut biopsy with laparoscopy in the diagnosis of high-grade serous ovarian cancer (HGSC) in our clinic. MATERIAL AND METHODS: Our retrospective study included patients who underwent surgery for HGSC between January 2013 and December 2023. Patients with pathologically confirmed (FIGO 2018) stage III or IV HGSC underwent neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) were performed. Exclusion criteria were patients with stage I and II ovarian cancer and who did not receive NACT. Additionally, patients with non-high-grade serous ovarian cancer or non-gynecological conditions were excluded. As a result, 60 patients were included in the study. Participants were categorized into two groups, namely, Group 1 (Patients diagnosed with HGSC by tru-cut biopsy before NACT) and Group 2 (Patients diagnosed with HGSC by diagnostic laparoscopy before NACT). Time-to-event analyses were conducted using the Kaplan- Meier method and log-rank test. Statistical significance was defined when p < 0.05. RESULTS: Out of the 60 patients, 32 patients were diagnosed by tru-cut biopsy and 28 patients with laparoscopy. The overall survival (OS) of Group 1 was 53.1%, and for Group 2, it was 71.4% (p = 0.371). The progression-free survival (PFS) rate was 56.3 for Group 1 and 64.3% for Group 2 (p = 0.464). No significant difference was detected in terms of recurrence, OS and PFS. We found a significant difference between Group 1 and Group 2 only in terms of hospitalization time (p < 0.001). CONCLUSIONS: HGSC is a histopathological subgroup of ovarian cancer that is difficult to diagnose and manage. While primary debulking surgery remains in the background, the importance of tru-cut biopsy in terms of short hospital stay should not be forgotten in the diagnostic evaluation of patients.

P-13 EXTRANODAL LYMPHOMA WITH ENDOCRINE ORGAN INVOLVEMENT: CASE REPORTS

Abstract Introduction The incidence of extranodal lymphomas has increased in the last decade, most commonly occurring in the gastrointestinal tract, head and neck, skin/soft tissue and central nervous system. We report two cases of extranodal lymphoma in the thyroid and adrenal gland. Clinical Cases A 61-year-old male patient diagnosed with Small Lymphocytic Lymphoma (CLL) was referred to us after his follow-up at the Hematology Clinic. Thyroid ultrasonography (USG) revealed a nodular ovoid lesion, that has a semisolid structure of 36x12 mm in size, with a cystic component in the center, located at the right lobe - isthmus junction, and with increased vascularity. Laboratory tests were as in Table 1. It was learned that the patient had received chemotherapy for CLL in 2009 and was in remission, and there was no family history of thyroid cancer. Since the fine needle aspiration biopsy (FNAB) was suspicious for lymphoid neoplasia, a tru-cut biopsy was performed. The flow cytometry result was found to be compatible with B-cell clonality, and the pathology result revealed mature B-cell neoplasia infiltration. Immunohistochemically, dense plasma cells were observed with CD138. Thyroidectomy was recommended to the patient, but he refused and was followed up. A 73-year-old female patient was referred to our clinic with the suspicion of adrenal insufficiency due to ongoing nausea, vomiting, and hypotension symptoms. Laboratory tests at presentation were as shown in Table 2. The patient was started on 80 mg/day methylprednisolone, which was thought to be acute adrenal insufficiency biochemically and clinically, and since hyperkalemia persisted, 0.05 mg/day fludrocortisone was added to the treatment. It was learned that the patient had been examined for abdominal pain for 6 months, and 15 mm nodular lesions were observed in both adrenal glands in the abdominal CT, but no further examination was performed. In adrenal CT, lesions measuring 41x30 mm on the right and 30x22 mm on the left at the body-medial crus level were observed in both adrenal glands, with a density higher than expected for adenoma (Figure 1). The findings were evaluated as significant in favor of nonadenomatous lesions, and due to progression in lesion sizes and high suspicion of malignancy, pheochromocytoma was excluded by checking urine catecholamines from the lesion in the right adrenal gland, and a tru-cut biopsy was performed. As a result of the pathology, the patient was diagnosed with high-grade B-cell neoplasia and hematological treatment was started. Conclusion Extranodal lymphoma involvement has been described with multiple different presentations in every tissue of the body, even within an organ system. Therefore, it should be included in the differential diagnosis of mass lesions. Tissue biopsy and immunohistochemistry are the most important methods for determining the specific subtype and cell origin.Figure 1:CT images of patientLesions in bilateral adrenal glands Table 1:Laboratory workup*Thyroid Stimulating Hormone. Table 2:Laboratory workup*Blood Urea Nitrogen,C-reactive Protein, Adrenocorticotropic hormone, Thyroid Stimulating Hormone

P-66 A INSTANCE OF PAPILLARY THYROID CANCER MANIFESTED WITH SCAPULAR METASTASIS

Abstract Introduction Bone metastasis of well differentiated thyroid tumors observed in 2% and 13% of the patients. Bone metastasis usually occurs mostly in spine, but also in extremities, rib cage and pelvic bones. Here we present a case differentiated thyroid cancer diagnosed with scapular bone metastasis. Clinical Case A 58-year-old male patient had pain on his left scapula that began a year ago. The intensity of the pain worsened over the months. It did not wake him up, but it worsened when he slept on his back. There was no history of trauma, shortness of breath, or pain while swallowing. Physical examination revealed soreness and abnormality at the lateral edge of the scapula. The thyroid gland was not palpable. He was diagnosed with benign prostatic hyperplasia. His family did not have a history of malignancy. He was a lifelong nonsmoker who consumed alcohol infrequently. A magnetic resonance imaging (MRI) of the left shoulder was scheduled due to a suspicious tumor seen on shoulder x-ray imaging. An MRI revealed a 44x40 millimeter mass lesion, T1A hypointense and T2A hyperintense, superimposed on the body of the scapula, causing bone structural enlargement (Figure 1). A tru-cut biopsy was performed, and the pathology results were consistent with thyroid cancer metastases. Positron emission tomography/computed tomography was planned for further metastatic investigation; no new metastases were identified. Hemoglobin: 14.3 g/dL, platelets: 192x109/L creatinine: 0.85 mg/dL calcium: 9.13 mg/dL, AST/ALT: 14/13 U/L, TSH: 1.67 mIU/L, free T4: 0.94 ng/dL. Ultrasonography showed 16x8x8 mm hypoechoic solid nodule with microcalcifications was seen in the posterior of the left lobe and 7x6 mm hypoechoic solid nodule was seen in the posterior right lobe, and reactive lymph nodes smaller than 1 cm were discovered in the bilateral cervical chain. A fine needle aspiration biopsy of a thyroid left lobe inferior nodule revealed follicular neoplasm bethesda V. Total thyroidectomy was performed. Pathology report revealed papillary carcinoma with a classic+follicular pattern, localized in the right lobe, invasion of the tumor capsule, and multifocal intrathyroidal and lymphatic invasion were present. The mitotic index was 0–1/2 mm². The patient’s cancer stage was T1bNxM1, STAGE 4B according to thyroid cancer staging calculator. Risk score was evaluated as high according to American Thyroid Association. Bone metastases received 30 GY of radiation over a 10-day period. 150 mci radioactive iodine therapy (RAI) was scheduled for two months after radiation treatment. Anti-thyroglobulin antibody 12.8 U/mL (0-115), thyroglobulin 0.0693 µg/L, TSH 0.013 mIU/L, and freeT4 1.28 ng/dL at fourth month following surgery under levothyroxin suppression medication. Conclusion Papillary thyroid cancer with bone metastasis shortens life expectancy. Total thyroidectomy, anti-resorptive bone agents, corticosteroids, RAI, metastasectomy, radiotherapy, tyrosine-kinase inhibitors are the treatment options.Figure1:44*40 milimeter mass lesion on scapula

Rare Rib-Originating Solitary Plasmacytoma: Retrospective Analysis and Surgical Outcomes.

Rare Rib-Originating Solitary Plasmacytoma: Retrospective Analysis and Surgical Outcomes.

The Role of Transthoracic Ultrasound-Guided Tru-Cut Biopsy in the Diagnosis of Peripheral Lung Lesions

The Role of Transthoracic Ultrasound-Guided Tru-Cut Biopsy in the Diagnosis of Peripheral Lung Lesions

Lesions of uncertain malignant potential in breast: Role of multiparametric MRI and histopathological correlation

Objectives This study aims to retrospectively evaluate the role of multiparametric magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, in predicting the histopathological upgrade of B3 breast lesions. The primary objective is to calculate the mean ADC values for B3 and B5 lesions. The secondary objective involves evaluating the kinetic enhancement patterns of these lesions. Materials and Methods This retrospective analysis includes patients who underwent MR mammography between 2019 and 2023 in our institution and subsequently underwent trucut biopsy and histopathologically proven to be either B3 or B5 category breast lesions. Results Student’s t-test was used to find out the significant difference in ADC between the two groups. B5 lesions had lower mean ADC value (0.8 ± 0.2 ×10–3 mm2/sec, p = 0.026), whereas B3 lesions had higher mean ADC value (1.1 ± 0.3 × 10–3 mm2/sec, p = 0.026). Conclusion The multiparametric MRI including DWI in high-risk breast lesions would help in predicting their pathological behavior non-invasively. Identifying the mean ADC value and MR morphological characteristics in these lesions may guide clinicians in reducing misdiagnosis and over-treatment.

Carbonic Anhydrase IX Enzyme in Triple Negative Breast Carcinoma: Relationship With Prognostic Factors and Response to Neoadjuvant Chemotherapy.

Triple negative breast carcinoma (TNBC) is characterized by the absence of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 receptor expression. Carbonic anhydrase IX (CA IX) is a tumor-associated cell surface glycoprotein that is involved in adaptation to hypoxia-induced acidosis and plays a role in cancer progression. The aim of this study was to investigate CA IX expression in TNBC and its relationship with treatment effect. Immunohistochemical staining was performed on tru-cut biopsy materials with CA IX antibody. Positive staining was graded as low (<10%) and high (>10%). In addition, the relationship between tumor diameter, histological grade and the treatment effect on mastectomy materials performed after neoadjuvant treatment was evaluated. TNBCs with positive staining for CA IX exhibited higher histological grade, and higher Ki-67 index compared to TNBCs with negative staining (p < 0.05). The response to treatment decreased as the degree of CA IX staining increased. There was no significant difference between the high staining group and low staining group in terms of patient age, tumor diameter and breast localisation. CA IX enzyme is a poor prognostic marker in TNBC cases. However, overexpression of CA IX was associated with reduced response to treatment.

Blood Cytokine Profile in Breast Cancer: Focusing on Differences among Molecular Subtypes.

Breast cancer is the leading cause of cancer-related deaths in women. Cytokines have been linked to various cancers, and both benign and malignant breast diseases are associated with inflammation. However, there is limited understanding of how the immune system's cytokine response varies among different subtypes of breast cancer. To assess cytokine levels in breast cancer patients according to their subtypes and investigate the potential role of these cytokines in treatment. Patients with stage 1-2 breast cancer and healthy volunteers were included in the study. The breast cancer patients were classified as luminal A, luminal B, and triple negative based on ER, PR, HER2 receptor status, and Ki67 score of trucut biopsy results. Multiplex assay and flow cytometry were used to quantify the concentrations of IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p (p70), IL-17A, IL-18, IL-23, and IL-33 in serum samples collected from all participants. Age, menopausal status, and hematologic parameters were also compared between groups. The study involved 19 luminal A, 20 luminal B, 18 triple-negative patients and 21 healthy volunteers. TNF-α, IL-6, IL-8, IL-10, IL-12p (p70), IL-18, and IL-23 cytokines were significantly higher in breast cancer patients than in healthy volunteers. Significant differences in IFN-γ, IL-6, IL-8, IL-10, IL-12p (p70), IL-17A, IL-18, and IL-23 were observed between subtypes, with triple-negative patients showing lower cytokine levels, except for MCP-1. The decreased levels of cytokines in triple-negative breast cancer indicate lower immunogenicity leading to more aggressive tumor progression as a result of an insufficient immune response.

Who Are Suitable Patients for Omitting Breast Surgery as an Exceptional Responder in Selected Molecular Subtypes of Breast Cancer After Neoadjuvant Systemic Treatment?

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. Materials and Methods: This two-centre, observational, single-arm, prospective, pilot study was conducted between January and September 2024. The patients with TN or HER2 positive breast cancer whose breast tumour had completely disappeared on the radiological assessment including MRI after neoadjuvant therapy were enrolled. To assess neoadjuvant treatment response, a standardised biopsy protocol was used, consisting of 10 samples from the marked tumour area per patient by 12 G core needle. Then, all patients underwent surgery. The pathological results of both postchemo-presurgical biopsy and surgical breast specimen were compared. Results: The study included 20 patients. The mean age of the patients was 47.3 years. The median tumour size at diagnosis was 23.1 mm. All biopsy results were concordant with the findings of surgical specimen. Seventeen patients had a complete response. The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery.

Retrospective evaluation of computed tomographic-guided Tru-Cut biopsies in 16 dogs and 14 cats with nasal cavity mass lesions.

Approximately 80% of nasal masses in dogs and 91% of nasal masses in cats are reported to be malignant, but the currently reported diagnostic rate of neoplasia is 54% using blind or rhinoscopic biopsy techniques. Describe the technique of computed tomography (CT)-guided Tru-Cut (Tru-Cut biopsy needle, Merit Medical Systems, Utah, USA) nasal biopsies in cats and dogs to determine the diagnostic rate of neoplasia on the first round of sampling and to evaluate the safety of the technique. Thirty client-owned animals, 16 dogs and 14 cats, that had CT-guided nasal biopsies performed to investigate nasal masses. Retrospective, single-center, medical record review of 16 dogs and 14 cats that had CT-guided nasal biopsies performed between 2022 and 2024. Diagnostic biopsy samples were acquired using CT-guided Tru-Cut sampling in 28/30 cases (93%). The diagnosis was considered clinically appropriate in 26/30 cases (87%): neoplasia in 24/30 cases (80%) and rhinitis in 2/30 cases (7%). Neoplasia was the final diagnosis in 14/16 dogs (88%) and 10/14 cats (71%). Computed tomographic-guided Tru-Cut biopsies can result in a high first-round diagnosis of neoplasia in nasal masses in cats and dogs, without clinically relevant complications. This technique is a useful alternative method of sampling nasal masses that may be difficult to access via rhinoscopy.

Ultrasonographic features of feline gastrointestinal eosinophilic sclerosing fibroplasia on initial presentation and during follow-up.

The aim of this study is to describe the ultrasonographic features of feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) before histological diagnosis and during follow-up after surgical excision and/or medical treatment. This multicentric retrospective case series study includes medical records of cats diagnosed histologically, which had an ultrasound before diagnosis and a minimum of one follow-up ultrasound at least 4weeks after treatment. Thirty cats were included in the study. The average age was 4.9 years (IQR 3.3-9.3 years). In 25 cases, the mass affected the gastrointestinal system, most commonly the proximal duodenum (36%: 9/25). Three masses originated from the lymph nodes, and two were mesenteric. The most common clinical signs were chronic vomiting, weight loss, and anorexia/reduced appetite. In 25 of 30 (83%) FGESF gastrointestinal cases, ultrasonographically, the lesions generally presented as focal, circumferential, eccentric masses with loss of layering, heterogeneous echogenicity, and hyperechoic areas. Hyperechogenicities in the peritoneum were observed in 63% of the cases, and enlarged lymph nodes (88%) were common. On final follow-up, 55% of the patients had complete resolution of the main lesion, peritoneal changes, and lymphadenopathies ultrasonographically. The disease recurred in 11 of 30 (37%), and progression was reported in 10 of 30 (33%) cases during the follow-up. Initially, 9 of these 10 were diagnosed via nonexcisional biopsy (endoscopic biopsy, Trucut biopsy, surgical incisional biopsy) and treated medically; only one patient had had surgical resection of the mass. Clinical signs at the time of recurrence or progression were inconsistent. Feline gastrointestinal eosinophilic sclerosing fibroplasia shows ultrasonographic features similar to neoplasia but commonly demonstrates hyperechoic areas. Data were assessed for normality and then assessed with appropriate parametric or nonparametric tests accordingly. Progression of the disease at any time during the follow-up was more common in cats treated medically than those treated surgically (P=.02). Clinical signs may or may not be present at the time of ultrasonographic recurrence or progression.

ATYPICAL PRESENTATION OF METASTATIC LOBULAR BREAST NEOPLASM

The diagnosis of cholecystitis is based on physical examination, laboratory tests, and abdominal ultrasound. After cholecystectomy, the surgical specimen is sent to the pathology department for routine histopathological examination to rule out pre-malignant and malignant conditions. Even less common is metastatic breast cancer that has spread to the gallbladder, which is itself a rare occurrence. We present a case of a 55-year-old female patient who underwent cholecystectomy for symptomatic chronic calculous cholecystitis. On histological examination, to the utmost surprise, a metastatic deposit in the wall of the gallbladder was detected by the pathologist, with a specific pattern of cell disposition, pointing to the primary site to be the breast, of which the patient was totally unaware. Metastasis in the gallbladder from primary lobular carcinoma of the breast was confirmed by a Tru-Cut biopsy from an ill-defined right breast lesion, with immunohistochemistry showing positive E-cadherin staining. Symptoms of right hypochondrial pain with nausea and vomiting in a patient should be investigated meticulously, as it can ultimately lead to the diagnosis of primary breast cancer. The role of the pathologist is emphasized in tracing the primary source of cancer and arriving at a clinical diagnosis.

A CASE OF MIXED INFILTRATING (LOBULAR AND DUCTAL) BREAST CARCINOMA IN A PREVIOUSLY DIAGNOSED PATIENT OF UDH

Introduction: Breast carcinoma has a heterogenous clinical and pathological presentation. Here is a female of 41 years, with a clear-cut, painless mass of the left breast for three years. Her radiology consisted of an USG which had an evidence of heterogeneously hypoechoic space occupying lesion in left breast with evidence of few ipsilateral, subcentimetric, lymph nodes in left axilla (BIRADS ¾). Her tru-cut biopsy had earlier showed Usual Ductal Hyperplasia (UDH) but her excisional biopsy revealed 'Infiltrating Mixed (Lobular+Ductal) Carcinoma with Usual Ductal Hyperplasia'. Thus, a Modified Radical Mastectomy (MRM) was done under General Anesthesia and the specimen was sent to our histopathology laboratory which revealed Invasive Carcinoma with Mixed Lobular and Ductal features; Lymph nodes, left, axillary dissection: 17/17 positive. Nottingham Grade III (3+3+3=9). Discussion: Diagnosing cases of DCIS is not an issue but the problem arises in differentiating benign intraductal lesions from invasive carcinoma. Conclusion: To the best of our understanding, this is a rare presentation case where there is transformation from benign intraductal lesion into mixed invasive (ductal and lobular) carcinoma.

A Case of Tumour Twins: A Rare Presentation of Simultaneous Breast and Endometrial Malignancies

The probability of simultaneous Breast Carcinoma (BC) and Endometrial Carcinoma (EC) in one person is extremely low and might be only a co-incidence. Hereby, the authors present a case report of a 62-year-old female presented to the Outpatient Department (OPD) with complaints of postmenopausal bleeding for a period of six months. On examination, her abdomen was enlarged, and a right breast mass was also noted incidentally. An ultrasound of the abdomen showed a thickened endometrium. A screening mammogram revealed a Breast Imaging-Reporting and Data System (BI-RADS) 4B lesion in the lower central quadrant of the right breast. Subsequently, an endometrial aspiration was done and showed features of atypical endometrial hyperplasia. A Tru-cut biopsy of the right breast mass was taken, showed features of a mucinous neoplasm favouring mucinous carcinoma, Nottingham’s histological grade 1. Immunohistochemistry (IHC) work-up favoured a Luminal A molecular subtype of mammary carcinoma. Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) imaging were also done which revealed a thickened endometrium with increased metabolic activity. Patient underwent a right Modified Radical Mastectomy (MRM), total abdominal hysterectomy with bilateral salpingo-oophorectomy, and lymph node sampling. Grossly, the MRM specimen showed a single, grey-white, firm, infiltrative lesion measuring 2.2×2.2×1.5 cm in the lower central quadrant. Microscopy showed a neoplastic tissue composed of nests of tumour cells floating in lakes of abundant extracellular mucin. The hysterectomy specimen revealed a grey-white to grey-brown endometrial polyp measuring 3.5×2.5 cm, which microscopically showed tumour cells arranged in sheets and in a glandular and papillary pattern with fibrovascular core. IHC for microsatellite instability and p53 were done.

Agreement between Ki-67 Proliferative Index in Breast Cancer by Conventional Hotspot Method and International Ki-67 in Breast Cancer Working Group Global Scoring Method: A Cross-sectional Study

Introduction: The role of the Ki-67 Proliferative Index (PI) in the molecular classification and as a predictive and prognostic biomarker in breast cancer is definitive. To address the inconsistency in Ki-67 interpretation and scoring, the International Ki-67 in Breast Cancer Working Group (IKWG) introduced the visual scoring Android Application (APP) and proposed a standardised scoring method. Aim: To determine Ki-67 proliferative indices by both the Global Method (GW) with the Ki-67 visual scoring app recommended by IKWG and conventional institutional Hotspot Method (HM), and to analyse the agreement between the indices obtained by these two methods. Materials and Methods: A cross-sectional study involving 71 Ki-67 immunostained hormone receptor-positive trucut biopsies of breast cancers from January 2022 to January 2024 were retrospectively collected. Two observers independently scored the biopsies using HM and GW by an app in the Department of Pathology of a tertiary care centre. The GW scores of Ki-67 PI obtained were categorised into low, intermediate and high groups based on 2015 St. Gallen guidelines. A two-way random Intraclass Correlation Coefficient (ICC) was used to assess the absolute agreement between two scorers. Results: The overall intraclass correlation between interobserver values by HM was 0.819 (good), while it was 0.971 (excellent) by GW. The overall interobserver mean difference was five times greater (p-value=0.008, statistically significant) than the overall interobserver global weighted scores (p-value=0.901, not statistically significant). Conclusion: The study highlighted the significant interobserver variability in HM compared to GW scores by the app. The standardised app scoring method has the potential to broaden the prognostic role of Ki-67 as a companion diagnostic tool.

Diagnostic Accuracy of Mammography for Breast Cancer Diagnosis, Taking Histopathology asStandard Investigation

Objective: To find out the exact accuracy of diagnosis of Mammography for females presented with breast lump.Study Design: A cross-sectional observational studyPlace and Duration of Study: Ward 3, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Sep 2021 to Dec 2021.Methodology: Total 210 female patients above 35 years of age, with breast lump presented in outpatient department of Jinnah postgraduate Medical Centre enrolled in this study. Out of 210 patients, 80 patients were provisionally diagnosed as benign breast lump i-e BIRADS I, II and III, and 130 as malignant i-e BIRADS IV, V, and VI were included on the basis of Mammography done from Radiology department. Trucut biopsy of the breast lump of more than 2cm and excision biopsy of the lump less than 2cm was done. Final diagnosis of histopathological report compared with provisional diagnosis. Results were noted on Performa and analyzed.Results: A total of 210 patients were enrolled in the study on the basis of Mammography. Out of 210 patients, 130(61.9%) patients were considered as malignant and 80(38.1%) patients as benign lumps. Diagnostic accuracy of Mammography was 96.19%, taking histopathology as standard investigation. The sensitivity, specificity, positive predictive value, and negative predictive value, were 98.41%, 92.86%, 95.38%, and 97.50%, respectively.Conclusion: Mammography proved significantly diagnostic for carcinoma of breast.